Provider Demographics
NPI:1205822640
Name:DESAI, PRATIK S (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:S
Last Name:DESAI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2296 OPITZ BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3300
Mailing Address - Country:US
Mailing Address - Phone:703-680-2111
Mailing Address - Fax:703-878-3939
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-680-2111
Practice Address - Fax:703-878-3939
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2011-05-27
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Provider Licenses
StateLicense IDTaxonomies
VA0101239046208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI11517Medicare UPIN